Prospectors Camp (Girls 12 and up) - REGISTRATION

If paying by cheque, contact the Camp Registrar above for mailing information.
​Make cheques payable to Camp Manitou.

Cancellation Fee Return Policy:

  • Up to 3 weeks before Camp: 90% Return
  • 3 weeks to 48 hours before Camp: 50% Return
  • Less than 48 hours before or Leave during Camp: No Refund

 Bursaries are available to subsidize fees, please make a request to the Camp Director.

Camper Information

Camper's Name *
Date of Birth *
Preferred Name
Preferred Pronouns
Age at Camp time *
Camper's Street Address *
City *
Prov *
P Code *
Camper's Home Phone (with area code) *
Camper's Swimming Level *
Cabin Mate Request
First Time at Camp Manitou?*
YES
NO
If yes, who referred you?

Please indicate the size for camper’s FREE Camp Manitou T-Shirt:

YOUTH
M
L
ADULT
S
M
L

Parent/Guardian

Please ensure that the email address indicated is clear and correct as email is the primary means of communication between Director and Parent.

1st Parent/Guardian *
Cell Phone
Home Phone
Work Phone
Email *
I authorize Camp Manitou Bay of Islands to communicate with me via email.*
YES
NO
2nd Parent/Guardian
Home Phone
Cell Phone
Work Phone
Email
I authorize Camp Manitou Bay of Islands to communicate with me via email.
YES
NO
Legal Custody Arrangement (if any)

Alternate Emergency Contact Phone Numbers

Name
Phone (with area code)
Relationship to camper
Phone (with area code)

 

 

Name
Phone (with area code)
Relationship to camper
Phone (with area code)

 

 

Doctor's Name
Phone (with area code)
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Health Information

Ontario Health Number *
Drug Plan Name
Height *
Date of last tetanus shot *
Drug Plan Number
Weight *
Immunizations Up-to-date?*
YES
NO

Allergies/Susceptibilities (Provide details below if necessary)


Camp Manitou will try to accommodate the special requirements of campers concerning allergies and/or dietary requirements whenever possible. However, due to the location of the camp and the type of facilities available we cannot guarantee that all needs will be adequately met. Please identify and discuss any and all allergies, health conditions, dietary requirements, etc. with the Camp Director at least one month before the
beginning of camp.

Foods
Medicines
Insect Bites
Other
Reactions
Reactions
Reactions
Reactions
Check any of the following that apply to your child.
Frequent headaches
Menstrual cramps
Fainting spells
Chronic ear infections
Visual or hearing disorders
Anaphylactic reactions
Epilepsy
Diabetes
Heart defects
Sleep walking
Bed wetting
Trouble sleeping
Attention deficit disorders
Developmental disabilities
Nose bleeds
Asthma or other breathing disorders
If you checked any of the above, please outline specifically the condition and usual treatment.
List any concerns which may prevent your child from participating fully in a vigorous camp program (ie significant past experiences, fears)
SMOKING IS NOT PERMITTED AT CAMP MANITOU. Does your child smoke?*
YES
NO

PARENT/GUARDIAN AUTHORIZATION

Please indicate that you have read, and agree with the following:*
To the best of my knowledge the above named applicant is in good health. She/He has my permission to participate in a vigorous and demanding camp program that includes swimming, canoeing and hiking. I understand that camp programming may include an overnight camping trip off camp premises.
I understand that while every care and attention will be given to the health, safety, and comfort of the camper, neither the Camp Director nor Camp Manitou Bay of Islands can be held responsible for any accident that may occur. Should emergency medical care be required, I hereby authorize the Camp Director to secure such medical advice and services as deemed necessary for the health and welfare of the camper. I agree to accept financial responsibility for costs in excess of the benefits allowed under the Ontario Hospital and Camp Insurance plans.
I understand Camp Manitou is a remote, boat access only, facility and as such emergency evacuation can be a challenge.
I give full permission for the use of photograph, electronic and video image by Camp Manitou for promotional use in the media, Manitou publications or website and Facebook.
I have read, and agree with the Parent/Guardian Authorization above.
Name of Parent / Guardian *

CAMPER'S APPLICATION

I understand that Camp Manitou is a natural treasure, therefore I declare that while attending Camp Manitou, I will respect the Environment, as well as other campers and staff.*
I agree
Date *
What activities are you looking forward to at Camp Manitou?
Privacy Agreement *

By checking this box I agree to allow Camp Manitou Bay of Islands to share my or my dependents’ personal information (name, birthdate, OHIP number, drug plan number, allergies, medications, etc) with necessary parties such as healthcare providers or pharmacies in the event that urgent medical attention or intervention is required.

Prospectors Camp (Girls 12 and up)
Total
$ 0.00
Prospectors Camp (Girls 12 and up)
0.00
REGISTER/PAY NOW
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